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Questions and Answers
What enzyme family is responsible for the detoxification of a wide range of electrophilic compounds in the human lung?
What enzyme family is responsible for the detoxification of a wide range of electrophilic compounds in the human lung?
Which of the following is NOT an obstructive lung disease?
Which of the following is NOT an obstructive lung disease?
What is a primary characteristic of the exudative phase of ARDS?
What is a primary characteristic of the exudative phase of ARDS?
What is the primary cause of cyanosis?
What is the primary cause of cyanosis?
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Which type of lung disease is characterized by impaired airflow?
Which type of lung disease is characterized by impaired airflow?
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Which of the following is NOT a direct cause of lung injury that can lead to ARDS?
Which of the following is NOT a direct cause of lung injury that can lead to ARDS?
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Which of the following CYP enzymes is known to be expressed in human lung tissue?
Which of the following CYP enzymes is known to be expressed in human lung tissue?
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What is the main symptom associated with the proliferative phase of ARDS?
What is the main symptom associated with the proliferative phase of ARDS?
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The interaction of BP-7,8-diol-9,10-epoxide with DNA is an example of:
The interaction of BP-7,8-diol-9,10-epoxide with DNA is an example of:
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Which of the following is NOT a phase II enzyme involved in the detoxification of metabolites in the lung?
Which of the following is NOT a phase II enzyme involved in the detoxification of metabolites in the lung?
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What does the term 'hypoxemia' refer to in the context of ARDS?
What does the term 'hypoxemia' refer to in the context of ARDS?
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What is the role of NADPH-cytochrome P450 reductase in the detoxification process?
What is the role of NADPH-cytochrome P450 reductase in the detoxification process?
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Which phase of ARDS is characterized by increased collagen deposition?
Which phase of ARDS is characterized by increased collagen deposition?
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What is the primary function of IgE in the context of allergic reactions?
What is the primary function of IgE in the context of allergic reactions?
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Which of the following cell types is NOT a major site of xenobiotic-metabolizing CYP enzyme expression in the lung?
Which of the following cell types is NOT a major site of xenobiotic-metabolizing CYP enzyme expression in the lung?
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Which symptom is NOT typically associated with ARDS?
Which symptom is NOT typically associated with ARDS?
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What is the probability of a child inheriting two copies of the mutant CFTR gene if both parents are carriers of the mutation?
What is the probability of a child inheriting two copies of the mutant CFTR gene if both parents are carriers of the mutation?
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What is the primary function of cilia in the airways?
What is the primary function of cilia in the airways?
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What is the most common mutation of the CFTR gene in Caucasians?
What is the most common mutation of the CFTR gene in Caucasians?
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What happens to the cilia when the mucus in the airways becomes dehydrated and thickens?
What happens to the cilia when the mucus in the airways becomes dehydrated and thickens?
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How many amino acids make up the CFTR protein?
How many amino acids make up the CFTR protein?
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What is the role of airway surface liquid (ASL) in maintaining airway health?
What is the role of airway surface liquid (ASL) in maintaining airway health?
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How does the CFTR protein regulate the volume of ASL?
How does the CFTR protein regulate the volume of ASL?
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What is the function of the CFTR protein?
What is the function of the CFTR protein?
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Which of the following is NOT a consequence of a defective CFTR protein?
Which of the following is NOT a consequence of a defective CFTR protein?
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What is the consequence of a malfunctioning CFTR protein in relation to ASL volume?
What is the consequence of a malfunctioning CFTR protein in relation to ASL volume?
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What is the role of cilia in the lungs?
What is the role of cilia in the lungs?
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What are the primary consequences of depleted ASL volume in the airways?
What are the primary consequences of depleted ASL volume in the airways?
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Where is the CFTR gene located?
Where is the CFTR gene located?
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Which of the following is NOT a common bacterial pathogen associated with cystic fibrosis lung infections?
Which of the following is NOT a common bacterial pathogen associated with cystic fibrosis lung infections?
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What is the relationship between the CFTR protein and ATP binding cassette (ABC) proteins?
What is the relationship between the CFTR protein and ATP binding cassette (ABC) proteins?
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What is the primary reason for the development of digital clubbing in individuals with cystic fibrosis?
What is the primary reason for the development of digital clubbing in individuals with cystic fibrosis?
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Which of the following is NOT a symptom commonly observed in individuals with cystic fibrosis?
Which of the following is NOT a symptom commonly observed in individuals with cystic fibrosis?
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What is the underlying cause of cystic fibrosis (CF)?
What is the underlying cause of cystic fibrosis (CF)?
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What is the primary cause of centroacinar emphysema?
What is the primary cause of centroacinar emphysema?
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Which of these is NOT a characteristic of emphysema?
Which of these is NOT a characteristic of emphysema?
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What is the role of α1-antitrypsin in the lungs?
What is the role of α1-antitrypsin in the lungs?
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How does panacinar emphysema differ from centroacinar emphysema?
How does panacinar emphysema differ from centroacinar emphysema?
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What is the primary goal of biotransformation in the lungs?
What is the primary goal of biotransformation in the lungs?
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What is the effect of nicotine on neutrophils in the context of emphysema?
What is the effect of nicotine on neutrophils in the context of emphysema?
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Which of the following enzymes is NOT involved in Phase I reactions of biotransformation?
Which of the following enzymes is NOT involved in Phase I reactions of biotransformation?
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What is the primary function of elastin in the lungs?
What is the primary function of elastin in the lungs?
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What is the primary mechanism by which Phase II reactions in biotransformation increase water solubility?
What is the primary mechanism by which Phase II reactions in biotransformation increase water solubility?
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Which of the following best describes the process of metabolic bioactivation?
Which of the following best describes the process of metabolic bioactivation?
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Which of the following enzymes plays a critical role in the development of emphysema?
Which of the following enzymes plays a critical role in the development of emphysema?
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What is the main distinction between panacinar and centroacinar emphysema?
What is the main distinction between panacinar and centroacinar emphysema?
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What is the role of epoxide hydrolase (EH) in the bioactivation of benzo(a)pyrene?
What is the role of epoxide hydrolase (EH) in the bioactivation of benzo(a)pyrene?
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Which enzyme is responsible for the final step in the bioactivation of benzo(a)pyrene into a reactive form that can bind to DNA?
Which enzyme is responsible for the final step in the bioactivation of benzo(a)pyrene into a reactive form that can bind to DNA?
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What is the major source of benzo(a)pyrene, a classic example of a pre-carcinogen activated by biotransformation?
What is the major source of benzo(a)pyrene, a classic example of a pre-carcinogen activated by biotransformation?
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What is the significance of the bioactivation of benzo(a)pyrene in terms of human health?
What is the significance of the bioactivation of benzo(a)pyrene in terms of human health?
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Flashcards
CYP Superfamily
CYP Superfamily
Group of enzymes responsible for the oxidative metabolism of xenobiotics and endogenous compounds.
P450 Monooxygenases
P450 Monooxygenases
Enzymes that use molecular oxygen to oxidize substances, requiring NADPH for function.
Phase I Metabolism
Phase I Metabolism
First stage of xenobiotic metabolism, primarily through oxidation by P450 enzymes.
Phase II Enzymes
Phase II Enzymes
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Glutathione S-transferases (GSTs)
Glutathione S-transferases (GSTs)
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Obstructive Lung Diseases
Obstructive Lung Diseases
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Restrictive Lung Diseases
Restrictive Lung Diseases
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Xenobiotics
Xenobiotics
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Biotransformation
Biotransformation
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Phase I reactions
Phase I reactions
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Cytochrome P450
Cytochrome P450
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Phase II reactions
Phase II reactions
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Glutathione S-transferase
Glutathione S-transferase
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Metabolic bioactivation
Metabolic bioactivation
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Benzo(a)pyrene
Benzo(a)pyrene
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ARDS
ARDS
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Three phases of ARDS
Three phases of ARDS
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Exudative Phase
Exudative Phase
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Proliferative Phase
Proliferative Phase
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Fibrotic Phase
Fibrotic Phase
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Signs of lung injuries
Signs of lung injuries
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Cyanosis
Cyanosis
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Direct lung injury causes
Direct lung injury causes
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Emphysema
Emphysema
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Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD)
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Types of Emphysema
Types of Emphysema
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Panacinar Emphysema
Panacinar Emphysema
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Alpha-1 Antitrypsin
Alpha-1 Antitrypsin
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Centroacinar Emphysema
Centroacinar Emphysema
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Elastase
Elastase
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Smoking and Emphysema
Smoking and Emphysema
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Autosomal Recessive Inheritance
Autosomal Recessive Inheritance
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CFTR Gene
CFTR Gene
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Most Common CFTR Mutation
Most Common CFTR Mutation
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CFTR Protein Structure
CFTR Protein Structure
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Function of CFTR Protein
Function of CFTR Protein
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Role of Chloride Ions
Role of Chloride Ions
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Cilia Function in Lungs
Cilia Function in Lungs
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Consequences of CFTR Dysfunction
Consequences of CFTR Dysfunction
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Cilia function
Cilia function
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Cystic fibrosis (CF)
Cystic fibrosis (CF)
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CFTR protein
CFTR protein
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Airway Surface Liquid (ASL)
Airway Surface Liquid (ASL)
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ENaC channel
ENaC channel
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Mucin secretion
Mucin secretion
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Bacterial infections in CF
Bacterial infections in CF
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Pulmonary symptoms of CF
Pulmonary symptoms of CF
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Digital clubbing
Digital clubbing
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Inflammation and obstruction
Inflammation and obstruction
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Study Notes
Metabolism and Bioactivation of Toxins in Pulmonary Tissue; α1-Antitrypsin Deficiency Syndrome
- Alpha-1 antitrypsin protects lungs from proteases.
- The liver releases alpha-1 antitrypsin into the blood.
- Deficiency of alpha-1 antitrypsin leads to lung tissue damage.
- Build-up of abnormal alpha-1 antitrypsin in the liver leads to liver cirrhosis.
Biotransformation in Lungs
- Lungs metabolize foreign compounds.
- Biotransformation modifies xenobiotics for easier elimination.
- The goal is to remove lipophilic substances that would accumulate in cell lipids.
- This process is achieved by enzymes capable of introducing new functional groups (Phase I reactions) or conjugating them with internal molecules to enhance water solubility (Phase II reactions).
Xenobiotic-Metabolizing Enzymes in Human Lung
- Phase I reactions involve oxidation reactions catalyzed by cytochrome P450-dependent monooxygenases and flavin monooxygenases, and reductions catalyzed by P450 reductase.
- Phase II reactions are catalyzed by GST (glutathione-S-transferase), UDP-glucuronyltransferase, epoxide hydrolase, sulphotransferase, and N-acetyltransferase.
Scheme of Xenobiotic Detoxification
- Phase I reactions convert xenobiotics into reactive electrophiles.
- Phase II reactions detoxify the reactive electrophiles, making them more hydrophilic.
- Reacts with proteins and DNA
- These metabolites may be cleaved by enzymes in the kidney and colon to produce mutagens and carcinogens.
- The final products are excreted.
Metabolic Bioactivation
- Biotransformation of foreign compounds can be beneficial for eliminating them.
- However, it can also activate harmless substances into reactive forms, such as the metabolic activation of benzo(a)pyrene for binding to DNA and leading to cancer.
- CYP450 enzymes are involved in the activation and subsequent detoxification of benzo[a]pyrene (B[a]P).
Expression of P450 Enzymes in Pulmonary Tissue
- P450 monooxygenases are responsible for the oxidative metabolism of xenobiotics, drugs, environmental pollutants, and carcinogens.
- P450 enzymes utilize oxygen and NADPH-cytochrome P450 to oxidize xenobiotics and generate water.
- CYP1A1, CYP1B1, CYP2B6, CYP2E1, CYP2J2, and CYP3A5 are expressed in the lung, bronchial epithelium, Clara cells, type II pneumocytes, and alveolar macrophages.
Expression of Phase II Enzymes in Pulmonary Tissue
- Phase II enzymes play a role in the elimination of metabolites.
- GSTs, UGTs, and epoxide hydrolases are present in pulmonary tissue.
- GSTs catalyze the conjugation of glutathione to a variety of endogenous and exogenous electrophilic compounds.
Diseases of the Respiratory System
- Non-infective diseases are grouped into obstructive and restrictive types.
- Obstructive diseases include emphysema, chronic bronchitis, bronchiectasis, and asthma (impaired airflow).
- Restrictive diseases involve restriction of lung expansion due to fibrosis.
What is Emphysema?
- Emphysema is characterized by loss of elastic recoil in the lungs.
- This leads to increased compliance and the inability to expel air from the lungs.
- Air gets trapped in the alveoli, which cluster together, forming blebs.
- Emphysema is a form of COPD.
Causes of COPD
- Cigarette smoking, α1-antitrypsin deficiency, hypocomplementemic urticarial vasculitis, intravenous Ritalin abuse, Ehlers-Danlos syndrome, Marfan syndrome, Salla disease, α1-antichymotrypsin deficiency, and HIV (emphysema-like illness) are possible COPD causes.
Classification of Emphysema
- Emphysema is classified into panacinar and centrilobular types.
- Panacinar emphysema involves all portions of the acinus and secondary pulmonary lobule uniformly, usually in the lower lobes.
- Centrilobular emphysema primarily affects the respiratory bronchioles, usually in the upper lobes.
Emphysema and α1-Antitrypsin
- Elastin is a lung protein and the enzyme elastase, secreted by neutrophils, breaks it down.
- α1-antitrypsin inhibits elastase to prevent the degradation of elastin and the damage seen in emphysema.
- Deficiency of α1-antitrypsin, especially in smokers, leads to the destruction of lung tissue due to loss of elastin.
Alpha-1 Antitrypsin Deficiency
- In normal conditions, alpha-1 antitrypsin protects lungs from damage by enzymes.
- In deficiency, alpha-1 antitrypsin is trapped in the liver, causing liver damage. In the lungs, neutrophil elastase is not inhibited; therefore, lung damage occurs.
Centroacinar Emphysema
- Centroacinar emphysema mainly affects the respiratory bronchioles.
- Cigarette smoke containing nicotine contributes to this type of emphysema by acting as a major attractant for neutrophils.
- Nicotine increases the activity of several pathways resulting in an increase in neutrophil activation and elastase.
Bronchitis
- Bronchitis involves inflammation of the bronchial mucus membranes.
- It can be acute or chronic.
- Acute bronchitis is usually caused by a temporary irritant like an infective agent (virus or bacteria) or an environmental irritant.
- Cough and mucus production are common symptoms.
Asthma
- Asthma is a chronic respiratory inflammatory condition characterized by intermittent, variable, and partly reversible constriction of bronchiolar smooth muscles.
- This can cause airway obstruction and result in difficulty breathing.
- Severe cases result in obstruction that is difficult to treat and wheezes become silent.
- The condition is associated with an inflammatory response and elevated immunoglobin E (IgE).
Asthma
- Asthma is associated with an inflammatory response causing the overproduction of IgE, which blocks beta-2 receptors in smooth muscles.
- The beta-adrenergic theory of asthma explains the mechanism behind this condition.
Asthma
- Genetic and other variables can make cells in the bronchi hypersensitive to environmental triggers.
- Environmental triggers stimulate an immune response (B-cell/helper T-cell (Th2) response) resulting in the production of antibodies to the trigger.
- This can cause a hypersensitivity response resulting in IgE production from plasma cells, interacting with mast and basophil cells.
Acute Respiratory Distress Syndrome (ARDS)
- ARDS is a severe lung condition defined by hypoxemia and stiff lungs.
- It occurs in response to various injuries and progresses through different phases.
- The pathology of ARDS involves an exudative, proliferative, and fibrotic phase.
Phases of ARDS
- Exudative phase: inflammation, increased vascular permeability, neutrophil influx, decreased surfactant, and impaired endothelial cells.
- Proliferative phase: decrease in type II pneumocytes, early fibrotic changes, and thickened alveolar capillaries.
- Fibrotic phase: increased collagen deposition and decreased compliance.
Lung Injuries and Symptoms
- Direct lung injuries include pneumonia, breathing in smoke, use of ventilators, and nearly drowning.
- Indirect lung injuries include sepsis, blood transfusions, severe chest injuries, severe bleeding, pancreatitis, fat embolism, and drug reactions.
- Common symptoms of lung injuries include dyspnea, tachypnea, and hypoxemia. Severe cases might lead to hypotension, confusion, and cyanosis.
Cyanosis
- Cyanosis is the bluish discoloration of the skin and mucous membranes due to low oxygen levels in the blood.
- It's caused by low oxygen levels in the red blood cells or difficulties in oxygenating the blood due to certain lung or heart conditions.
Biochemical Basis of Lung Injuries
- Inflammation is a crucial component in lung injuries, leading to increased vascular permeability, edema, neutrophil and macrophage influx, and damage to alveoli.
- Impaired oxygen exchange, increased breathing rate, and respiratory acidosis are results of the inflammatory response.
- Fibrous tissue deposition, collapse of alveoli, and decrease in compliance are caused by further inflammation and dysfunction of type II alveolar cells.
Cystic Fibrosis (CF)
- CF is an autosomal recessive multisystem disease caused by mutations in the CFTR gene.
- Chronic sino-pulmonary disease, nutritional deficiency/GI abnormality, and electrolyte abnormality are commonly observed conditions in CF.
Who is Affected by CF?
- CF affects about one in 2,500 people of European descent.
- Median survival is 25 years, and the number of patients reaching their 30s is increasing.
Autosomal Recessive Inheritance in CF
- CF is an autosomal recessive disorder.
- If both parents carry the CFTR gene mutation, there is a 25% chance of a child inheriting the disease, and a 50% chance of being a carrier.
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Gene
- The CFTR gene is located on chromosome 7; the F508 mutation is common in Caucasians.
- There are 1522 mutations identified in the CFTR mutation database.
The Cystic Fibrosis Transmembrane Conductance Regulator (CFTR)
- CFTR is a protein made of 1,480 amino acids forming a specific 3D structure.
- It's a member of the ATP-binding cassette (ABC) superfamily.
- The CFTR protein acts as an ion channel, moving chloride ions across epithelial membranes.
What Does the CFTR Protein Do?
- CFTR is an ion channel moving chloride ions from inside the cell to outside.
- These chloride ions attract a water layer that helps cilia sweep away mucus.
Disease-Causing Mutation Subclasses in Cystic Fibrosis
- There are over 1700 CFTR mutations classified into 5 categories based on pathogenic mechanisms.
- Some mutations are approved for treatment with CFTR modulators.
- Different populations have different frequencies for specific mutations.
How Do Problems With the CFTR Protein Cause CF?
- Problems with the CFTR protein lead to the trapping of chloride ions inside the cell.
- This reduces water outside the cell and causes the mucus to become dehydrated and thick, impairing ciliary function.
- Mucus buildup obstructs airways, provides a breeding ground for bacteria, and causes infections.
Airway Surface Liquid Low Volume Hypothesis
- Clearance of mucus depends on ciliary function and secretion.
- Optimal volume of airway surface liquid (ASL) facilitates bacteria entrapment.
- ASL volume is regulated by the absorption of Na+ ions and secretion of Cl- ions.
- Defects in CFTR reduce Cl- secretion, decreasing ASL volume.
Airway Surface Liquid Low Volume Hypothesis and CFTR
- Normal CFTR inhibits sodium channels (ENaC).
- This inhibition reduces sodium absorption, which has a downstream effect on ASL volume.
- In CF, mutant CFTR does not inhibit ENaC properly, increasing sodium absorption and reducing ASL volume.
- This reduced ASL volume leads to poor mucociliary clearance, accumulation of mucus, and increased bacterial infection risk.
Airway Surface Liquid Low Volume Hypothesis and Consequences
- Depleted ASL volume negatively affects ciliary function, impairing mucus clearance.
- This results in concentrated mucus that adheres to the airway surface, increasing the susceptibility to chronic infections.
CF Lung Pathophysiology
- Diminished host defenses lead to recurring bacterial infections.
- Common bacterial pathogens in CF include Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae, and Burkholderia cepacia.
- The subsequent inflammation, infection, and obstruction lead to bacterial toxins, impaired gas exchange, and chronic respiratory failure.
CF Symptoms
- Pulmonary Symptoms: cough, increased sputum production, recurrent pneumonia, and digital clubbing.
- Gastrointestinal Symptoms: pancreatic enzyme insufficiency, fat-soluble vitamin deficiency, and malnutrition.
Diagnosis-Sweat Chloride
- Sweat chloride tests are used to diagnose cystic fibrosis.
- Elevated sweat chloride levels (60-165 meq/L) indicate cystic fibrosis.
Prenatal Screening
- The American College of Obstetricians and Gynecologists recommends carrier testing for CF mutations during pregnancy.
- Testing sensitivity for CF among the white population is relatively low (~78%).
- The testing sensitivity is lower in racial and ethnic minority populations.
Cystic Fibrosis-Treatment is Multidisciplinary
- Treatment of cystic fibrosis requires a multidisciplinary approach.
- Key components include airway clearance, infection management, nutritional support, gastrointestinal care, inflammation management, and fertility counseling, as well as social support.
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Description
Test your knowledge on lung diseases, especially focusing on ARDS, its phases, and the enzymes involved in detoxification processes in the human lung. This quiz covers various obstructive lung diseases, the biochemical interactions, and related symptoms. Perfect for students in medical and biological sciences!